1/39. magnetic resonance imaging findings of Kernohan-Woltman notch in acute subdural hematoma.OBJECTIVE AND IMPORTANCE: We report the case of a 73-year-old patient who presented a right motor deficit caused by an ipsilateral acute subdural hematoma. A magnetic resonance imaging (MRI) demonstration of Kernohan-Woltman notch phenomenon was obtained. CLINICAL PRESENTATION: The woman sustained a major head injury at home, followed by loss of consciousness. On admission to the emergency room, she was comatose, anisochoric (left > right), and showed a reaction to pain with decerebrating movements of left limbs (glasgow coma scale (GCS) 4/15). A right severe hemiparesis was observed. Cerebral computed tomography scan showed a large right hemispheric subdural hematoma. INTERVENTION AND POST-OPERATIVE COURSE: A wide right craniotomy was performed and the subdural hematoma evacuated. During the post-operative period, the level of consciousness gradually improved. A MRI performed about 2 weeks after operation showed a small area of abnormal signal intensity in the left cerebral peduncle. On discharge, the woman was able to communicate with others, but her right hemiparesis was still severe.- - - - - - - - - - ranking = 1keywords = cerebral (Clic here for more details about this article) |
2/39. Pure acute subdural haematoma without subarachnoid haemorrhage caused by rupture of internal carotid artery aneurysm.A 52-year-old female presented with disturbance of consciousness and clinical signs of tentorial herniation. Computed tomography showed a pure acute subdural haematoma (SDH) over the left convexity without subarachnoid haemorrhage. cerebral angiography showed a saccular aneurysm at the junction of the left internal carotid artery and the posterior communicating artery. Surgery to remove the haematoma and clip the aneurysm showed the rupture point was located in the anterior petroclinoid fold (subdural space). The patient recovered without neurological deficits. Pure SDH caused by ruptured aneurysm is rare. rupture of an aneurysm adhered to either the dura or falx and located in the subdural space may cause pure SDH. Therefore, ruptured intracranial aneurysm should be considered as a cause of non-traumatic SDH. Immediate removal of the SDH and aneurysmal clipping is recommended in such patients, even those in poor neurological condition.- - - - - - - - - - ranking = 23.517151237893keywords = haemorrhage (Clic here for more details about this article) |
3/39. Fatal subdural haemorrhage following lumbar spinal drainage during repair of thoraco-abdominal aneurysm.A 63-year-old male patient collapsed and died from a major subdural haemorrhage 5 days after elective repair of a Type III thoraco-abdominal aortic aneurysm. The anaesthetic technique had included the use of a lumbar cerebrospinal fluid drain. The management of the patient is described, and the association between subdural haemorrhage and cerebrospinal fluid drainage is discussed.- - - - - - - - - - ranking = 28.220581485472keywords = haemorrhage (Clic here for more details about this article) |
4/39. Schwannoma of the cervical spine presenting with acute haemorrhage.Acute haemorrhagic presentation of spinal schwannoma is a rare event. A case of cervical spinal schwannoma presenting with spontaneous spinal subdural and intramedullary haemorrhage is described.- - - - - - - - - - ranking = 23.517151237893keywords = haemorrhage (Clic here for more details about this article) |
5/39. Acute subdural hematoma in patients who underwent aneurysm clipping--four case reports.Four patients presented with intracranial hemorrhage mainly consisting of acute subdural hematoma (ASDH), who had all undergone aneurysm clipping 2-20 years earlier. Whether the clips had slipped or new trauma had caused the bleeding was difficult to determine, since the initial computed tomography showed that the subarachnoid hemorrhage or the intracerebral hematoma developed near the clips. Angiography in three patients showed that the clips had not slipped off. Three of four ASDHs appeared in the same side as the craniotomy used for the previous aneurysm surgery. Anti-platelet agents and ventriculoperitoneal shunting had been previously used in two patients with no causal signs of trauma. The outcomes were poor in three patients and one patient died. Weakening of the extra- or intracranial structure after aneurysm surgery might have been involved together with the postoperative anti-platelet agent and shunt treatment in the etiology of the present ASDH.- - - - - - - - - - ranking = 1.7006053816555keywords = cerebral, intracerebral (Clic here for more details about this article) |
6/39. Abnormal pupillary activity in a brainstem-dead patient.The pupils in brainstem-dead patients are classically fixed and dilated. We present a case of a brainstem-dead patient whose pupils displayed persistent asynchronous pupillary constriction and dilatation independent of external physical stimuli. Central causes for the phenomenon were excluded leaving an unexplained peripheral cause as the most likely explanation. Early recognition of this phenomenon prevents delay in the diagnosis of brainstem death, lessening to some extent the distress for the family, and facilitating earlier organ donation and allowing the better use of resources.- - - - - - - - - - ranking = 0.095642617966988keywords = brain (Clic here for more details about this article) |
7/39. Acute subdural hematoma caused by ruptured cerebral aneurysms: diagnostic and therapeutic pitfalls.On rare occasions, rupture of a cerebral aneurysm causes acute subdural hematoma (SDH) in addition to subarachnoid hemorrhage (SAH). The frequency of SDH resulting from aneurysmal rupture is summarized, and its clinical and radiological characteristics, as well as potential pitfalls in the diagnosis and the management of this life-threatening condition are described. Among 641 patients with nontraumatic SAH treated between 1992 and 2000, 12 patients (1.9%) presented with SDH due to aneurysmal rupture. The SAH grade on admission was grade II in one patient, grade IV in three patients, and grade V in eight patients. Four underwent both hematoma evacuation and clipping of the aneurysm, four underwent hematoma evacuation alone, and the other four patients were treated conservatively. The outcome was good recovery in two patients, severe disability in one patient, and death in nine patients. patients with a good outcome had a better SAH grade on admission, smaller midline shift, and smaller SDH volume on the initial CT scan, and they had been treated by both SDH evacuation and clipping of the aneurysm. Emergency one-stage operations may be beneficial for aneurysmal SDH patients who are in good SAH grade, or those who are in poor SAH grade but show some neurological recovery after resuscitation. It should also be mentioned that there are cases of aneurysmal SDH without recognizable SAH on the CT scans, and that a case of aneurysmal SDH may present as a case of 'head trauma' after an accident, because of the disturbance of consciousness resulting from aneurysmal rupture.- - - - - - - - - - ranking = 5keywords = cerebral (Clic here for more details about this article) |
8/39. Giant aneurysm of the pericallosal artery causing acute subdural hematoma--case report.A 66-year-old female presented with a very rare giant aneurysm of the distal pericallosal artery. She lost consciousness and was admitted. Computed tomography demonstrated a subdural hematoma over the left cerebral convexity and a mass in the frontal lobe. cerebral angiography disclosed a giant aneurysm located on the distal segment of the right pericallosal artery. The subdural hematoma was removed and the aneurysmal neck was clipped, but she died 15 days after the operation. autopsy found the giant aneurysm (33 x 30 x 27 mm) on the distal segment of the right pericallosal artery. Highly atheromatous changes were recognized in part of the aneurysmal wall, the arteries near the circle of willis, and the distal anterior cerebral artery (ACA) adjacent to the aneurysm. There were no anomalous vessels such as azygos ACA. Giant aneurysms situated beyond the genu of the corpus callosum are extremely rare. atherosclerosis was probably a major etiological factor in this case.- - - - - - - - - - ranking = 2keywords = cerebral (Clic here for more details about this article) |
9/39. Kernohan's notch phenomenon: a case study.In a patient suffering from brain herniation due to a right-sided subdural hematoma, a neurological examination should show left-sided deficits, known as localizing signs, and a decreased level of consciousness. However, false localizing signs may be present, attributed to pressure on Kernohan's notch. A case study demonstrates these false localizing signs, known as Kernohan's notch phenomenon.- - - - - - - - - - ranking = 0.013663231138141keywords = brain (Clic here for more details about this article) |
10/39. Single burr hole evacuation for traumatic acute subdural hematoma of the posterior fossa in the emergency room.A 57-year-old man and a 55-year-old man presented with acute subdural hematoma of the posterior cranial fossa due to trauma. Both were comatose preoperatively. Emergent single burr hole evacuation in the posterior cranial fossa was performed in the emergency room immediately after computed tomography. Neurological symptoms improved dramatically just after initiating the burr hole evacuation in both patients. A 57-year-old man became alert and could walk unassisted 1 month after surgery. The other could walk with assistance 4 months after surgery, although psychic disturbance resulting from cerebral contusion remained. Single burr hole evacuation in the emergency room is a useful treatment for acute subdural hematoma of the posterior cranial fossa because the procedure can be performed easily and rapidly, thus achieving reduction of intracranial pressure. Progressing neurological deterioration, reversibility of brainstem function by mannitol administration and the sign of brainstem compression and noncommunicating hydrocephalus are good indicators for this treatment.- - - - - - - - - - ranking = 1.0273264622763keywords = cerebral, brain (Clic here for more details about this article) |
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